Abstract
Despite evidence-based guidelines that advocate for dental care during pregnancy, dental utilization among pregnant women remains low, especially among low-income and racial–ethnic minority women. We investigated self-reported dental care referral and self-reported dental care attendance among a group of 298 low-income, largely racial–ethnic minority pregnant women attending two suburban prenatal care clinics that had integrated dental care referrals into their prenatal care according to these guidelines. We administered a questionnaire that asked women: (1) whether they had been referred for care by their prenatal care provider; (2) whether they had been seen by a dentist during pregnancy. Among those women who were eligible for a dental care referral (those who reported having dental symptoms, and those not having a recent dental visit), we found that 73.0% reported that they had indeed been referred for dental care by their prenatal provider, while the remaining women reported either no referral (23.5%, n = 67) or were not sure whether they had been referred (3.5%, n = 10). Among those who reported a dental care referral, 67.3% (n = 140) reported that they saw a dentist during their pregnancy, while of those who reported no dental care referral only 35.1% (n = 27) reported a dental visit (Chi-Sq. = 24.1, df = 1, p < 0.001). Having received a dental referral was a significant predictor of reporting a dental visit during pregnancy, with women who received a referral being 4.6 times more likely to report a dental visit during pregnancy compared to those women who did not report a referral. These results demonstrate that vulnerable pregnant women referred for dental care by their prenatal provider will indeed seek and utilize dental care when offered. This dental referral program may serve as a model for improving the utilization of dental care among this population.
Highlights
An adage says that “for every child, a woman loses a tooth.” [1]
When we applied the NY State Oral Health in Pregnancy Guidelines to our data, we found that 95.3% (n = 284) of the women we surveyed were eligible for a dental referral (we excluded those who reported having a recent dental visit only if they had no oral symptoms (4.7%, n = 13))
Multivariate Analysis: We further evaluated whether women who were referred for a dental visit by their prenatal care provider/clinic were more likely to report a dental visit controlling for race/ethnicity (White vs. minority), and found that, when controlling for minority racial–ethnic status, women who reported having received a referral for dental care by their prenatal provider/clinic were 4.6 times more likely to report a dental visit during pregnancy compared to those who reported no such referral
Summary
It has long been recognized that during pregnancy women are at an increased risk of oral disease primarily because of hormonal changes that adversely affect the oral soft tissues [2]. Gingivitis, inflammation of the gingiva, occurs in most pregnant women and worsens as pregnancy progresses [3,4]. Periodontal disease, characterized by destruction of the tooth-supporting structures (connective tissue and bone), is common in pregnant women [5] and can progress during pregnancy, especially if not treated [6]. Women may be at increased risk for caries (which causes pain, infection, and tooth loss) during pregnancy due to pregnancyrelated changes in diet, Ref. Low-income and minority women are at increased risk of dental disease, and disparities in oral health
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